Funding for local HIV/AIDS treatment and prevention services, many that primarily serve low- or no-income residents, will be reduced by $7 million over the next two years unless replacement money can be found in San Francisco's $7.9 billion budget.

HIV and AIDS care in San Francisco depends largely on small community-based nonprofits. About $20 million in federal funding has been cut from these service providers over the past three budget years, continuing a decade-long trend.

Federal grants for low-income and uninsured people at risk of HIV/AIDS has dropped from $34 million in 2001 to $18 million today, and funding from the Centers for Disease Control and Prevention is slated to drop by 50 percent — from $10 million to $5 million — over the next five years.

And with $11 million in cuts this year due to the federal sequester, free condoms and sex education — along with free meals, rent subsidies and hospice care — would be reduced or removed for thousands of patients, according to the Department of Public Health.

"We've faced cuts for so many years, we're already a lean machine," said Bill Hirsch, executive director of the AIDS Legal Referral Panel. "There isn't anything left to be cut."

Local tax dollars have replaced about $17.5 million in lost federal funding over the past three years.

It is not clear if that will be the case for the remaining holes — $3.1 million in the coming fiscal year and $3.9 million in the following year.

The City has successfully reduced new instances of HIV/AIDS from about 2,400 a year 20 years ago to about 200 in 2013, according to the health department.

But that means federal AIDS funding has been redirected to areas with higher infection rates, essentially punishing San Francisco "for our own success," said Supervisor Scott Wiener. He added that the budget decision is "terrible. It's completely irrational."

Latino communities — a "very vulnerable population," said Supervisor David Campos — stand to take a hard hit. Programs at Instituto Familiar de la Raza and AGUILAS would lose about $700,000 total over the next two years, health department budget documents show.

The cuts might sound small but most service providers are tiny neighborhood-based centers or nonprofits, which means "just a few dollars" in cuts can "derail" treatment, said Executive Director Perry Lang of the Black Coalition on AIDS.

About 35,000 people in San Francisco are living with HIV or AIDS, including one out of every three gay men, according to the HIV/AIDS Providers Network.

Mayor Ed Lee and the Board of Supervisors have until the end of the month to determine the final budget for the next two years.

It's expected that the funding will be restored, but the cycle is "harsh" on sick people, Hirsch said.